Managing Chronic Pain in Adults with Substance Use Disorders

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1 Question from chapter 1 Managing Chronic Pain in Adults with Substance Use Disorders 1) What is the percent of chronic pain patients who may have addictive disorders? a) 12% b) 22% c) 32% d) 42% 2) Which is NOT one of the 3Cs of addiction? a) Coercive behaviors b) Control c) Continued use d) Craving 3) Chronic pain syndrome involves intractable pain of or longer. a) 3 months b) 6 months c) 9 months d) 12 months 4) Pain is evaluated in the a) Dorsal horn b) Limbic system c) Somatosensory cortex d) Thalamic nuclei 5) Pain caused by sickle cell disease is described as which type of pain? a) Acute b) Acute intermittent c) Chronic d) Chronic intermittent 6) In the reward response, feelings of reward emerge from the core of the limbic system after neurons in the ventral tegmental area release the neurotransmitter a) Dopamine b) Serotonin c) Histamine d) Melatonin

2 7) NIDA (2007) estimates that between of a person s vulnerability to addiction may be genetic. a) 10 to 20% b) 20 to 40% c) 40 to 60% d) 60 to 70% 8) People with alcohol use disorders have been found to be more than times as likely to report nonmedical use of prescription medications as people who do not drink. a) 18 b) 24 c) 30 d) 36 Question from chapter 2 9) Because of their accuracy, standardized tools should be the absolute determinant of treatments offered or withheld. a) True b) False 10) Clinicians are especially likely to underestimate and undertreat pain and disability in all the following EXCEPT a) Elderly b) Men c) Minorities d) People with SUDs 11) Which tool to assess pain level is subject to measurement error? a) Faces Pain Scale b) Numeric Rating Scale c) McGill Pain Questionnaire d) Visual Analog Scale 12) Which is a tool to assess several dimensions of pain? a) Faces Pain Scale b) Numeric Rating Scale c) McGill Pain Questionnaire d) Visual Analog Scale

3 13) According to the NIAAA (2005), if a female patient has more than drinks per week, she is at increased risk for developing alcohol-related problems. a) 5 b) 7 c) 10 d) 14 14) Which tool has 24 yes/no questions and takes 10 minutes to administer? a) Drug Abuse Screening Test b) MAST c) AUDIT d) CAGE 15) Which can present as depression? a) Sleep apnea b) Hypothyroidism c) Hypogonadism d) All of the above 16) Many patients who have multiple unexplained symptoms have subsyndromal forms of a) Somatization disorder b) PTSD c) Personality disorder d) Depression 17) Patients who have chronic pain who score on measures of selfefficacy or have an locus of control report lower levels of pain, higher pain thresholds, increased exercise performance, and more positive coping efforts. a) Low, Internal b) Low, External c) High, Internal d) High, External 18) A score of or higher on the SOAPP-R suggests the patient is at high risk for problems with chronic opioid therapy. a) 5 b) 9 c) 15 d) 18

4 Question from chapter 3 19) The complete elimination of pain for a substantial period is the goal of pain management. a) True b) False 20) The primary adjuvant analgesics are a) Antipsychotics and Anxiolytics b) Anxiolytics and Antidepressants c) Antidepressants and Anticonvulsants d) Anticonvulsants and Antipsychotics 21) Which analgesic is addictive? a) Anticonvulsants b) Topical Analgesics c) Antipsychotics d) Benzodiazepines 22) Which is NOT a common nonpharmacological therapy for CNCP. a) Physical therapy b) Synthetic THC c) Cognitive behavioral therapy d) Complementary and alternative medicine 23) Van Ameringen and colleagues (2004) found the strongest evidence for the use of for panic disorder. a) Valproic acid b) Gabapentin c) Lamotrigine d) Pregabalin 24) Which is a limitation of opioid therapy? a) Diminished efficacy over time b) Adverse effects that many patients cannot tolerate c) Risk of addiction d) All the above 25) The majority of deaths secondary to methadone occur in the first 14 days of use because of all the following reasons EXCEPT a) The initial dose is too high b) It is titrated too quickly c) The patient has an undiagnosed cardiac condition d) It interacts with other drugs or medications

5 26) Patients who have chronic pain do not obtain adequate pain control through a single daily dose of methadone. a) True b) False 27) The most common opioid rotation is a) Oxycodone to Hydrocodone b) Hydrocodone to Morphine c) Morphine to Methadone d) Methadone to Oxycodone Question from chapter 4 28) In the context of pain treatment, a approach refers to a minimum standard of care applied to all patients who have CNCP, whatever their assessed risk. a) Manualized b) Evidence Based Practice c) Consumer based d) Universal precautions 29) Couto et al. (2009) studied data from the urine tests of 900,000 patients on chronic opioid treatment and found that of the patients showed at least one sign of nonadherence to opioid regimens. a) 55% b) 65% c) 75% d) 85% 30) Heit and Gourlay (2004) recommended testing for all the following substances during routine screening EXCEPT a) Alcohol b) Cocaine c) Methadone d) Marijuana 31) Behavior that suggests substance misuse, abuse, or addiction is known as a) Proneness to abuse b) Abuse markers c) Rule-outs d) Aberrant drug-related behavior

6 32) Which tool helps determine whether opioids have become a problem for the patient? a) Current Opioid Misuse Measure b) Opioid Abuse Survey c) Addiction Behaviors Checklist d) Survey of Opioid Use 33) Which tool asks patients about their behavior in the 30 days before the appointment? a) Current Opioid Misuse Measure b) Opioid Abuse Survey c) Addiction Behaviors Checklist d) Survey of Opioid Use 34) Which is NOT recommended as an activity which can help build a therapeutic relationship between the treatment team and the patient? a) Listening actively b) Using thinking statements c) Using clarification statements d) Demonstrating empathy 35) Medications taken by people other than for whom they are prescribed are said to be a) Boosted b) Off label c) Spanked d) Diverted 36) Symptoms of opioid withdrawal include all EXCEPT a) Bone and muscle pain b) Fever c) Anxiety d) Insomnia Question from chapter 5 37) The capacity to capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions is known as a) Patient competence b) Instructional validity c) Health literacy d) Patient rights

7 38) Schillinger et al. (2003) suggests that communication can be enhanced by using the method. a) Simon says b) Reflective listening c) Teach-back d) Parrot 39) The VA/DoD (2010) states that patients need to understand all the following about opioids EXCEPT a) The titration process b) The risks of discontinuing the medication abruptly c) How medication will be safely discontinued d) That hyperactivity is a common side effect during titration 40) Which is a common element of a treatment agreement? a) Limits on medication refills b) Consent for random urine drug testing and other specified testing c) Required pill counts d) All the above

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